EXIT HESI -PN Exam A PRACTICE
QUESTION
A 2-day postpartum mom who's breastfeeding asks, "Why do I experience this tingling in my
breasts after the toddler sucks for a couple of minutes?" Which facts should the nurse provide?
A.This feeling happens at some stage in feeding with a breast infection.
B.This sensation happens as breast milk movements to the nipple.
C.The toddler does now not have desirable latch-on.
D.The infant isn't always placed efficaciously. - ANS-B
When the mom's milk is available in, usually 2 to 3 days after shipping, ladies often file they
experience a tingling sensation of their nipples (B) whilst allow-down occurs. (A, C, and D)
provide erroneous records.
A 40-year-antique workplace employee who is at 36 weeks' gestation affords to the
occupational fitness clinic complaining of a pounding headache, blurry vision, and swollen
ankles. Which intervention should the nurse put in force first?
A.Check the client's blood strain.
B.Teach her to raise her ft whilst sitting.
C.Obtain a 24-hour eating regimen records to evaluate for the intake of salty ingredients.
D.Assess the fetal coronary heart price. - ANS-A
The blood strain (A) ought to be assessed first. Preeclampsia is a multisystem disorder, and
women older than 35 years and feature persistent high blood pressure are at multiplied hazard.
Classic signs and symptoms encompass headache, visible changes, edema, latest fast weight
advantage, and expanded blood stress. (B, C, and D) can be carried out if the blood strain is
regular.
A 50-year-old man arrives on the clinic with proceedings of ache on ejaculation. Which motion
ought to the nurse enforce?
A.Teach the patron testicular self-exam (TSE).
B.Assess for the presence of blood in the urine.
C.Ask approximately scrotal ache or blood inside the semen.
D.Inquire approximately a records of kidney stones. - ANS-C
Orchitis is an acute testicular irritation attributable to recurrent urinary tract infection, recurrent
sexually transmitted ailment (STD), or an indwelling urethral urinary catheter inflicting pain on
ejaculation, scrotal pain, blood in the semen, and penile discharge, so the nurse have to decide
the presence of different signs and symptoms (C). Although all men must practice TSE, the
client's symptoms are suggestive of an inflammatory syndrome as opposed to testicular most
,cancers (A). Although hematuria (B) is associated with renal disorder or calculi (D), the patron's
ache is associated with ejaculate, now not urine.
A seventy seven-year-old girl patron states that she has in no way been so big around the waist
and that she has common durations of constipation. Colon sickness has been dominated out
with a bendy sigmoidoscopy. Which records need to the nurse offer to this purchaser?
A.As women age, they frequently emerge as rounder inside the middle because they do no
longer exercising well.
B.Further evaluation is indicated due to the fact loss of belly muscle tone and constipation do
now not arise with growing older.
C.With age, more fatty tissue develops in the stomach and reduced intestinal motion can
motive constipation.
D.Because there's no proof of a diseased colon, there's no need to fear approximately stomach
length - ANS-C
With ageing, the belly muscle groups weaken as fatty tissue is deposited across the trunk and
waist. Slowing peristalsis also impacts the emptying of the colon, resulting in constipation (C).
(A) isn't always the number one cause for the modifications in body structure. (B) is not
indicated due to the fact lack of muscle tone and constipation are age-associated changes. (D)
dismisses the customer's worries and does now not help her apprehend the changes that she is
experiencing.
A toddler is having a generalized tonic-clonic seizure. Which motion must the nurse take?
A.Move objects out of the child's immediate region.
B.Quickly slip tender restraints on the child's wrists.
C.Insert a padded tongue blade between the tooth.
D.Place inside the restoration function earlier than going for help. - ANS-A
The first precedence at some stage in a seizure is to offer a secure environment, so the nurse
should clean the area (A) to lessen the threat of trauma. The baby have to not be restricted (B)
because this could cause greater trauma. Objects ought to no longer be located within the
child's mouth (C) because it may pose a choking hazard. Although (D) need to be implemented
after the seizure, the nurse have to not go away the kid at some stage in a seizure to get assist.
A toddler with nephrotic syndrome is receiving prednisone (Deltasone). Which desire of
breakfast meals at a fast food restaurant suggests that the mom is familiar with the nutritional
tips important for her child?
A.French toast sticks and orange juice
B.Sausage egg muffin and grape juice
C.Canadian bacon slices and hot chocolate
D.Toasted oat cereal and occasional-fats milk - ANS-D
,A toddler receiving a corticosteroid for nephrotic syndrome need to comply with a low-sodium,
low-fats, and occasional-sugar weight-reduction plan. Based on those tips, the nice breakfast
preference is (D). (A) is high in fat and sugar. (B and C) are excessive in fat and sodium.
A patron has been on a mechanical ventilator for several days. What ought to the nurse use to
document and file this consumer's respirations?
A.The respiration settings at the ventilator
B.Only the consumer's spontaneous respirations
C.The ventilator-assisted respirations minus the customer's unbiased breaths
D.The ventilator putting for respiratory rate and the client-initiated respirations - ANS-D
The nurse need to depend the patron's respirations, and document each the respiration fee set
via the ventilator and the consumer's unbiased respiratory fee (D). Never depend strictly on (A).
Although the consumer's spontaneous breaths could be shallow and device-assisted breaths
will be deep, it is important to document system-assisted breaths as well as the customer's
spontaneous breaths to get an average respiratory picture of the patron (B and C).
A client has been receiving levofloxacin (Levaquin), 500 mg IV piggyback q24h for 7 days. The
UAP reviews to the nurse that the consumer has had 3 unfastened foul-smelling stools this
morning. Which intervention is maximum essential for the nurse to put into effect?
A.Perform a digital evaluation for fecal impaction.
B.Administer a PRN dose of psyllium (Metamucil).
C.Obtain a stool specimen for culture and sensitivity.
D.Instruct the UAP to obtain incontinent pads for the consumer. - ANS-C
Long-term use of levofloxacin (Levaquin) can cause foul-smelling diarrhea due to Clostridium
difficile infection or related colitis, so it is most essential to gain a stool specimen (C). Impaction
is not going, so (A) is of less precedence and may not be necessary. (B) is a bulk-forming agent
that may be used for constipation or diarrhea. Treatment of the diarrhea and consumer
consolation (D) are essential interventions however of much less priority than figuring out the
purpose of the patron's diarrhea.
A patron hospitalized for meningitis is demonstrating nuchal tension. Which symptom is that this
patron in all likelihood to be showing?
A.Hyperexcitability of reflexes
B.Hyperextension of the top and returned
C.Inability to flex the chin to the chest
D.Lateral facial paralysis - ANS-C
Nuchal rigidity (neck stiffness) is a characteristic of meningeal irritation and is elicited with the
aid of trying to flex the neck and place the chin to the chest (C). Although (A, B, and D) may
additionally arise in meningitis, (A) describes exaggerated spinal nerve reflex responses, (B)
describes opisthotonus, and (D) can be related to cranial nerve pathology of the trigeminal
nerve.
, A purchaser is admitted to the intellectual health unit with a major complaint of crying,
depressed mood, and sleeping problems. While speakme approximately the dying of a pal, the
customer states, "I can not trust this happened." Which announcement with the aid of the nurse
is maximum therapeutic?
A."It seems like you are feeling very sad."
B."Tell me greater about how you're feeling."
C."How frequently do you've got crying spells?"
D."Do you need to talk approximately these feelings?" - ANS-B
It is most therapeutic to ask an open-ended query and encourage the patron to explore his or
her emotions (B). (A) is a main response, and the consumer may not be feeling unhappy. (C and
D) are near-ended questions that do not facilitate communication.
A purchaser reviews experiencing dysuria and urinary frequency. Which consumer coaching
have to the nurse offer?
A.Save the subsequent urine sample.
B.Restrict oral fluid intake.
C.Strain all voided urine.
D.Reduce physical hobby. - ANS-A
The nurse should instruct the customer to store the following urine sample (A) for commentary
of its look and for possible urinalysis. The purchaser is reporting signs and symptoms which
could suggest the onset of a urinary tract infection. Increased fluid consumption have to be
endorsed, until contraindicated (B). (C) is handiest vital if a calculus (stone) is suspected. (D)
isn't indicated through this consumer's symptoms.
A client tells the nurse that he is suffering from insomnia. Which facts is most important for the
nurse to gain?
A.The consumer's common drowsing pattern
B.Whether the consumer smokes
C.How lots liquid the patron consumes before bedtime
D.The quantity of caffeine that the customer consumes all through the day - ANS-A
The first component to determine is the purchaser's usual snoozing pattern and the way it has
changed to emerge as what the client describes as insomnia (A). (B, C, and D) offer additional
statistics after (A) is ascertained.
A client who is admitted with emphysema is having trouble respiration. In which role need to the
nurse vicinity the purchaser?
A.High Fowler's role without a pillow in the back of the head
B.Semi-Fowler's function with a single pillow at the back of the top
C.Right facet-lying position with the head of the mattress elevated forty five levels
QUESTION
A 2-day postpartum mom who's breastfeeding asks, "Why do I experience this tingling in my
breasts after the toddler sucks for a couple of minutes?" Which facts should the nurse provide?
A.This feeling happens at some stage in feeding with a breast infection.
B.This sensation happens as breast milk movements to the nipple.
C.The toddler does now not have desirable latch-on.
D.The infant isn't always placed efficaciously. - ANS-B
When the mom's milk is available in, usually 2 to 3 days after shipping, ladies often file they
experience a tingling sensation of their nipples (B) whilst allow-down occurs. (A, C, and D)
provide erroneous records.
A 40-year-antique workplace employee who is at 36 weeks' gestation affords to the
occupational fitness clinic complaining of a pounding headache, blurry vision, and swollen
ankles. Which intervention should the nurse put in force first?
A.Check the client's blood strain.
B.Teach her to raise her ft whilst sitting.
C.Obtain a 24-hour eating regimen records to evaluate for the intake of salty ingredients.
D.Assess the fetal coronary heart price. - ANS-A
The blood strain (A) ought to be assessed first. Preeclampsia is a multisystem disorder, and
women older than 35 years and feature persistent high blood pressure are at multiplied hazard.
Classic signs and symptoms encompass headache, visible changes, edema, latest fast weight
advantage, and expanded blood stress. (B, C, and D) can be carried out if the blood strain is
regular.
A 50-year-old man arrives on the clinic with proceedings of ache on ejaculation. Which motion
ought to the nurse enforce?
A.Teach the patron testicular self-exam (TSE).
B.Assess for the presence of blood in the urine.
C.Ask approximately scrotal ache or blood inside the semen.
D.Inquire approximately a records of kidney stones. - ANS-C
Orchitis is an acute testicular irritation attributable to recurrent urinary tract infection, recurrent
sexually transmitted ailment (STD), or an indwelling urethral urinary catheter inflicting pain on
ejaculation, scrotal pain, blood in the semen, and penile discharge, so the nurse have to decide
the presence of different signs and symptoms (C). Although all men must practice TSE, the
client's symptoms are suggestive of an inflammatory syndrome as opposed to testicular most
,cancers (A). Although hematuria (B) is associated with renal disorder or calculi (D), the patron's
ache is associated with ejaculate, now not urine.
A seventy seven-year-old girl patron states that she has in no way been so big around the waist
and that she has common durations of constipation. Colon sickness has been dominated out
with a bendy sigmoidoscopy. Which records need to the nurse offer to this purchaser?
A.As women age, they frequently emerge as rounder inside the middle because they do no
longer exercising well.
B.Further evaluation is indicated due to the fact loss of belly muscle tone and constipation do
now not arise with growing older.
C.With age, more fatty tissue develops in the stomach and reduced intestinal motion can
motive constipation.
D.Because there's no proof of a diseased colon, there's no need to fear approximately stomach
length - ANS-C
With ageing, the belly muscle groups weaken as fatty tissue is deposited across the trunk and
waist. Slowing peristalsis also impacts the emptying of the colon, resulting in constipation (C).
(A) isn't always the number one cause for the modifications in body structure. (B) is not
indicated due to the fact lack of muscle tone and constipation are age-associated changes. (D)
dismisses the customer's worries and does now not help her apprehend the changes that she is
experiencing.
A toddler is having a generalized tonic-clonic seizure. Which motion must the nurse take?
A.Move objects out of the child's immediate region.
B.Quickly slip tender restraints on the child's wrists.
C.Insert a padded tongue blade between the tooth.
D.Place inside the restoration function earlier than going for help. - ANS-A
The first precedence at some stage in a seizure is to offer a secure environment, so the nurse
should clean the area (A) to lessen the threat of trauma. The baby have to not be restricted (B)
because this could cause greater trauma. Objects ought to no longer be located within the
child's mouth (C) because it may pose a choking hazard. Although (D) need to be implemented
after the seizure, the nurse have to not go away the kid at some stage in a seizure to get assist.
A toddler with nephrotic syndrome is receiving prednisone (Deltasone). Which desire of
breakfast meals at a fast food restaurant suggests that the mom is familiar with the nutritional
tips important for her child?
A.French toast sticks and orange juice
B.Sausage egg muffin and grape juice
C.Canadian bacon slices and hot chocolate
D.Toasted oat cereal and occasional-fats milk - ANS-D
,A toddler receiving a corticosteroid for nephrotic syndrome need to comply with a low-sodium,
low-fats, and occasional-sugar weight-reduction plan. Based on those tips, the nice breakfast
preference is (D). (A) is high in fat and sugar. (B and C) are excessive in fat and sodium.
A patron has been on a mechanical ventilator for several days. What ought to the nurse use to
document and file this consumer's respirations?
A.The respiration settings at the ventilator
B.Only the consumer's spontaneous respirations
C.The ventilator-assisted respirations minus the customer's unbiased breaths
D.The ventilator putting for respiratory rate and the client-initiated respirations - ANS-D
The nurse need to depend the patron's respirations, and document each the respiration fee set
via the ventilator and the consumer's unbiased respiratory fee (D). Never depend strictly on (A).
Although the consumer's spontaneous breaths could be shallow and device-assisted breaths
will be deep, it is important to document system-assisted breaths as well as the customer's
spontaneous breaths to get an average respiratory picture of the patron (B and C).
A client has been receiving levofloxacin (Levaquin), 500 mg IV piggyback q24h for 7 days. The
UAP reviews to the nurse that the consumer has had 3 unfastened foul-smelling stools this
morning. Which intervention is maximum essential for the nurse to put into effect?
A.Perform a digital evaluation for fecal impaction.
B.Administer a PRN dose of psyllium (Metamucil).
C.Obtain a stool specimen for culture and sensitivity.
D.Instruct the UAP to obtain incontinent pads for the consumer. - ANS-C
Long-term use of levofloxacin (Levaquin) can cause foul-smelling diarrhea due to Clostridium
difficile infection or related colitis, so it is most essential to gain a stool specimen (C). Impaction
is not going, so (A) is of less precedence and may not be necessary. (B) is a bulk-forming agent
that may be used for constipation or diarrhea. Treatment of the diarrhea and consumer
consolation (D) are essential interventions however of much less priority than figuring out the
purpose of the patron's diarrhea.
A patron hospitalized for meningitis is demonstrating nuchal tension. Which symptom is that this
patron in all likelihood to be showing?
A.Hyperexcitability of reflexes
B.Hyperextension of the top and returned
C.Inability to flex the chin to the chest
D.Lateral facial paralysis - ANS-C
Nuchal rigidity (neck stiffness) is a characteristic of meningeal irritation and is elicited with the
aid of trying to flex the neck and place the chin to the chest (C). Although (A, B, and D) may
additionally arise in meningitis, (A) describes exaggerated spinal nerve reflex responses, (B)
describes opisthotonus, and (D) can be related to cranial nerve pathology of the trigeminal
nerve.
, A purchaser is admitted to the intellectual health unit with a major complaint of crying,
depressed mood, and sleeping problems. While speakme approximately the dying of a pal, the
customer states, "I can not trust this happened." Which announcement with the aid of the nurse
is maximum therapeutic?
A."It seems like you are feeling very sad."
B."Tell me greater about how you're feeling."
C."How frequently do you've got crying spells?"
D."Do you need to talk approximately these feelings?" - ANS-B
It is most therapeutic to ask an open-ended query and encourage the patron to explore his or
her emotions (B). (A) is a main response, and the consumer may not be feeling unhappy. (C and
D) are near-ended questions that do not facilitate communication.
A purchaser reviews experiencing dysuria and urinary frequency. Which consumer coaching
have to the nurse offer?
A.Save the subsequent urine sample.
B.Restrict oral fluid intake.
C.Strain all voided urine.
D.Reduce physical hobby. - ANS-A
The nurse should instruct the customer to store the following urine sample (A) for commentary
of its look and for possible urinalysis. The purchaser is reporting signs and symptoms which
could suggest the onset of a urinary tract infection. Increased fluid consumption have to be
endorsed, until contraindicated (B). (C) is handiest vital if a calculus (stone) is suspected. (D)
isn't indicated through this consumer's symptoms.
A client tells the nurse that he is suffering from insomnia. Which facts is most important for the
nurse to gain?
A.The consumer's common drowsing pattern
B.Whether the consumer smokes
C.How lots liquid the patron consumes before bedtime
D.The quantity of caffeine that the customer consumes all through the day - ANS-A
The first component to determine is the purchaser's usual snoozing pattern and the way it has
changed to emerge as what the client describes as insomnia (A). (B, C, and D) offer additional
statistics after (A) is ascertained.
A client who is admitted with emphysema is having trouble respiration. In which role need to the
nurse vicinity the purchaser?
A.High Fowler's role without a pillow in the back of the head
B.Semi-Fowler's function with a single pillow at the back of the top
C.Right facet-lying position with the head of the mattress elevated forty five levels
